Urinary Symptoms in the Female  Most urinary symptoms in the female are functional disorders  Management is directed towards improvement of quality of life.  If symptoms are of sudden onset or atypical, especially in the elderly, bladder malignancy should be considered with early referral to secondary care. Presentation Stress Urinary Incontinence (SUI) : Leakage on physical activity Overactive Bladder (OAB) symptoms : urgency, frequency, urge incontinence, nocturia, enuresis Mixed Urinary Incontinence: Both SUI and OAB symptoms Complicated Symptoms Haematuria Bladder pain Recurrent UTIs Voiding dysfunction Retention Suspected fistula Assessment History & Examination - Prev incontinence or prolapse surgery / Prev pelvic irradiation - Significant and/or Symptomatic prolapse / Pelvic mass - Atrophic changes in postmenopausal women  Treat with topical oestrogen - Post-void residual if indicated – If significant Urinalysis +/- MSSU - Positive for blood  Follow Haematuria Pathway - UTI  Treat with antibiotics Frequency-Volume-Chart Clinical Diagnosis Early Referral to Secondary Care SUI OAB + / - Incontinence Mixed Incontinence Primary Management Lifestyle interventions - Review fluid intake ( 1-1.5l per day ) - Reduce caffeine intake - Normalize weight / Stop smoking / Treat constipation Supervised and targeted pelvic floor muscle training/Physiotherapy for 15-20 weeks (See link to Referral Pathway below) Supervised bladder re-training for 15-20 weeks for OAB Drug therapy for OAB (see Prescribing Guidance)/Consider Duloxetine for SUI If symptoms persist Referral to Secondary Care for Specialised Management

Referral Pathway to Women’s Health Physiotherapists in the Community across Edinburgh and the Lothians (West/Mid/East) Referrals via SCI Gateway – Option: AHP – Physiotherapy. Edinburgh – Community MSK HUB (Slateford) AHP – Physiotherapy. East Lothian – Roodlands Hospital (East Lothian) AHP – Physiotherapy. Midlothian – Roodlands Hospital (Midlothian) AHP – Physiotherapy. St Johns Hospital (West Lothian) Referrals will be directed to one of the Community Physiotherapy Services MSK Outpatient Clinics. Referrals will be triaged appropriately to a Women’s Health Physiotherapist.